DR. CRAIG D. WAGGONER (NPI# 1578517439) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578517439 |
| Entity Type | Individual |
| Full Name | DR. CRAIG D. WAGGONER |
| Credential | PHD, MPAP |
| Practice Address |
4105 Kirkman St Lake Charles LA 70607-4603 |
| Practice Telephone | 3374758022 |
| Practice Fax Number | 3374758054 |
| Mailing Telephone | 3374758022 |
| Mailing Fax Number | 3374758054 |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2013-02-07 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TP0016X |
Psychologist Specialization: Prescribing (Medical) |
MPAP.000029 | LA | Behavioral Health & Social Service Providers |
| Street Address |
4105 KIRKMAN ST |
| City | LAKE CHARLES |
| State | LA |
| Zip Code | 70607-4603 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659988343 | Katie Bruce | Pharmacist | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2020-09-26 |
| 1598245623 | Imperial Calcasieu Human Services Authority | Clinic/Center | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2018-08-17 |
| 1730698838 | Rebecca Becky Perry | Social Worker | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2017-09-21 |
| 1538566336 | Troy Barrow | Registered Nurse | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2014-11-24 |
| 1992101240 | Clint Dupre | Licensed Practical Nurse | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2014-11-14 |
| 1386057891 | Vicki Ann Lebleu | Nurse Practitioner | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2014-06-03 |
| 1750792248 | Genoa Healthcare, LLC | Pharmacy | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2014-05-19 |
| 1376971200 | Lexi Berryhill | Social Worker | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2013-11-01 |
| 1700127487 | Dana Young | Counselor | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2013-03-06 |
| 1730420530 | Sandy Marie Faulk | Counselor | 4105 Kirkman St, Lake Charles, LA 70607-4603 | 2013-03-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710596283 | Dakota Loosemore | Student in an Organized Health Care Education/Training Program | 800 East Mcneese Street, Lake Charles, LA 70607 | 2020-07-30 |
| 1467003822 | Sarah Jane Walley | Specialist/Technologist | 800 E Mcneese Street, Lake Charles, LA 70607 | 2019-09-26 |
| 1770053902 | Antonio Rivera | Chiropractor | 2625 Dillard Loop, Suite C, Lake Charles, LA 70607 | 2018-11-30 |
| 1851861330 | Shannon Marie Melvin | Specialist/Technologist | 800 East Mcneese, Lake Charles, LA 70607 | 2018-11-28 |
| 1326517699 | Vincent Michael Williams | Specialist/Technologist | 800 East Mcneese St, Lake Charles, LA 70607 | 2018-11-16 |
| 1396263356 | Lake Area Physician Services LLC | Durable Medical Equipment & Medical Supplies | 10071 Hwy 385, Lake Charles, LA 70607 | 2017-08-30 |
| 1023556370 | Heath Bryan Coleman, Dds of Louisiana II, A Professional Dental LLC | Dentist | 2625 Dillard Loop, Ste A, Lake Charles, LA 70607 | 2017-02-07 |
| 1750741880 | Townsend Treatment Center, LLC | Substance Abuse Rehabilitation Facility | 635a Petro Point Dr, Lake Charles, LA 70607 | 2016-03-02 |
| 1194081414 | Clint Nickolas Lincoln | Family Medicine | 10071 Gulf Hwy, Lake Charles, LA 70607 | 2012-04-11 |
| 1295976652 | John Leroy Speer | Dentist | 3425 Louisiana Ave., Lake Charles, LA 70607 | 2009-03-16 |
| Find all providers in zip 70607 | ||||
| Taxonomy Code | 103TP0016X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Prescribing (Medical) |
| Those licensed psychologists who have completed specialized, post-doctoral training in psychopharmacology, passed a national proficiency examination in psychopharmacology, and who are authorized by state statute to prescribe medications, in accordance with their state law and state licensing authority, for the evaluation, diagnosis, management and treatment of mental, nervous, emotional, behavioral, and related disorders. |
| Notes: Source: Louisiana Academy of Medical Psychologists Note: Some states issue licenses under Medical Psychologist. [1/1/2007: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861627465 | Lakisha Shantell Williams | Psychologist | 1409 Kirkman St, Lake Charles, LA 70601-5344 | 2009-05-26 |
| 1104176825 | Beyond Words, Inc. | Psychologist | 1409 Kirkman St, Lake Charles, LA 70601-5344 | 2012-09-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790297182 | George S. Park, Phd., Mp., A Psychology Corporation | Psychologist | 2285 Benton Rd Ste 401, Bossier City, LA 71111-7933 | 2017-10-25 |
| 1669887907 | John Courtney LLC | Psychologist | 118 Terra Bella Blvd, Suite 101, Covington, LA 70433-8148 | 2014-06-25 |
| 1730520925 | Faw Services, LLC | Psychologist | 223 Bellingrath Pl, Madisonville, LA 70447-3421 | 2013-07-16 |
| 1134418502 | Psychological Health Care of South Louisiana | Psychologist | 1016 Houma St, Houma, LA 70360-4420 | 2011-04-06 |
| 1922234566 | Felicia Ann Whiteman | Psychologist | 2331 Carey St, Slidell, LA 70458-3627 | 2009-06-10 |
| 1710101373 | Rebecca Faye Nolan | Psychologist | 111 Carroll St, Shreveport, LA 71105-4203 | 2007-04-12 |
| 1013131267 | Dr. Maria B. Cruse Apmg | Psychologist | 604 North Acadia Road, Suite 201, Thibodaux, LA 70301 | 2007-04-12 |
| 1093860371 | Maxine Elizabeth Campbell-flint | Psychologist | 412 N 4th St, Suite 100, Baton Rouge, LA 70802-5523 | 2007-01-24 |
| 1104925932 | Williams Consulting Inc. | Psychologist | 1410 Royal Ave, Monroe, LA 71201-5608 | 2006-09-21 |
| 1043247331 | Bryan L Bolwahnn | Psychologist | 100 Gayven Dr, Ball, LA 71405-4903 | 2006-06-26 |
| Find all providers with the same taxonomy | ||||
| City | LAKE CHARLES |
| Zip Code | 70607 |
Please comment or provide details below to improve the information on DR. CRAIG D. WAGGONER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.